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Clinical Parameters

This presentation will probably involve audience discussion, which will create action items. Use PowerPoint to keep track of these action items during your presentation In Slide Show, click on the right mouse button Select “Meeting Minder” Select the “Action Items” tab

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Clinical Parameters

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  1. This presentation will probably involve audience discussion, which will create action items. Use PowerPoint to keep track of these action items during your presentation • In Slide Show, click on the right mouse button • Select “Meeting Minder” • Select the “Action Items” tab • Type in action items as they come up • Click OK to dismiss this box • This will automatically create an Action Item slide at the end of your presentation with your points entered. Clinical Parameters Furcation Recession Mobility

  2. Learning Outcomes

  3. Furcations: Clinical Considerations • May or may not be clinically exposed • Bifurcation: 2 rooted tooth • Trifurcation: 3 rooted tooth • Radiographs may aid diagnosis • Suspect furcation involvement when pockets measure 5-6 mm+ • Increased risk for root caries, root resorption, recession sensitivity, pulp involvement, abscess formation

  4. Furcations • Extension of bone loss between roots of teeth • Teeth with furcation involvement are high risk for continued attachment loss • Detection of furcation faciliated by using a specially designed furcation probe

  5. No. 2 Naber’s furcation probe & a narrow Michigan O periodontal probe Move probe towards location of the furcation & curve into furcation area Probing Furcations

  6. Probing Furcations • Access to furcations: • Mesial surface max. molars: • Best to approach from palatal direction b/c mesial furcation is palatal to midpoint of mesial surface • Distal surface of max. molars • Located more towards midline • Detected from buccal or palatal approach

  7. Probing Furcations • Most common site: mand. First molar • Least common site: max. first bicuspid

  8. Furcations: Classification, Characteristics, Treatment

  9. Furcations: Classification, Characteristics, Treatment

  10. Slimline access Radiographic assessment Furcations

  11. Root resection: Performed on vital or endodontically treated teeth Hemisection: Splitting of two rooted tooth into two parts Following sectioning, one or both roots can be retained Classification Root Resection & Hemisection

  12. Mobility • Risk factor for PD • Measure extent, determine cause • Normal physiologic movement not graded • Degree of mobility not always correlated to amount of bone loss

  13. Causes of Mobility • Mobility may be related to: • Trauma from occlusion • Loss of periodontal support • Gingival inflammation • Pregnancy & hormonal changes • Periodontal surgery • Minor mobility can usually be maintained • Increasing mobility – more frequent PMT and/or referral for surery

  14. Classification of Mobility • Nomenclature used varies across systems: • Class I etc. • Grade I etc. • I mobility etc. • Grade 1 etc. • 1, 2, 3

  15. Classification of Mobility • N=normal physiologic mobility • Grade I=slight mobility, up to 1 mm of horizontal displacement in a facial-lingual direction • Grade II=moderate mobility, > 1 mm of horizontal displacement • Grade III=severe mobility, greater than 1 mm of movement in any direction (horizontal & vertical) • Nield-Gehrig & Houseman, 1996 • Mobility can be measured using 2 instrument handles

  16. Recession • Disturbance to the gingiva results in an apical shift of the gingiva margin • Actual recession: • Level of the epithelial attachment on tooth • Apparent recession: • Level of the crest of the gingival margin

  17. Causes: Mechanical trauma: hard brush, vigorous technique Crown margins Periodontal disease Occlusal trauma Defects in bone Causes: Trauma from teeth in opposing jaw Oral habits, oral piercing Poorly designed partial dentures Tooth position Healing response following periodontal surgery Etiology of Gingival Recession

  18. Gingival Recession • Toothbrush Trauma

  19. Gingival Recession • Trauma from denture

  20. Gingival Recession • Oral Piercing

  21. Gingival Recession • Orthodontics

  22. Gingival Recession • Prominent Roots

  23. Gingival Recession • Frenal Attachment

  24. Symptoms/signs • Client usually complains of: • Sensitivity • Aesthetics • Complications: • Increased sensitivity • Loss of tissue from root surface (erosion, abrasion) – protective cementum removed • Caries • Greater risk for PD: greater surface area for plaque retention

  25. Treatment Options • Depends on cause • Nonsurgical treatment includes: • Debridement • Oral self-care instruction • Local medicaments for sensitivity

  26. Treatment Options • Surgical treatment: • Laterally positioned flap • Connective tissue graft

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